Contact Us Today!

3101 Emrick Blvd
Suite 318
Bethlehem, PA 18020
Toll Free: 877-456-5323
Fax: 610-974-8574

E-Mail: AFC Insurance

Submissions: submissions@afcins.com

Endorsements: endorsement@afcins.com

Claims Reporting: claims@afcins.com

Forms Directory

Here is a list of our most common forms.  These forms are in PDF format.
If you need the reader, please get it here: Get Adobe Reader

Chartis – Social Services:
Social Services Renewal Application
Social Services Residential Facility Supplement
Social Services Supplemental Application
Abuse Supplement
Swimming Pool Supplement
Business Interruption Worksheet

 


 

Chartis – Child Care Solutions:
Childcare Solutions Application

 

Chartis – Worker’s Compensation:
WC Supplemental Application (This form is not required unless requested.)

 

Chartis – D&O:
Not for Profit Main Application
Private Application – Main Form & Renewal
Ballpark Application D&O and EPLI
 

 

QBE – Health & Human Services:
Health & Human Services New Business Application
Health & Human Services Renewal Application
Health And Human Services Supplemental Application
Home Health New Business Application
Home Health Renewal Application

Swimming Pool Supplemental Application

Home Medical Equipment Dealer Application

 

Fireman’s Fund -  Pizza & Deli Operators:
Program Application
Owned Auto Application
Non-Owned Auto Application
Workers Compensation Application
Certificate of Insurance Request
Payment Card Security Extra Expense Questionnaire
Employment Practices Liability Insurance
Older Building Questionnaire  

 

Travelers - Paratransit
Auto Supplement Application

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disclaimer:
AIU Holdings is the marketing name for the worldwide property casualty and general insurance operations of AIU Holdings, Inc. and AIU Holdings LLC. For additional information, please visit our website at www.aiuholdings.com. In the United States, all products are written by insurance company subsidiaries of AIU Holdings, Inc. Coverage may not be available in all jurisdictions and is subject to actual policy language. Noninsurance products and services may be provided by independent third parties.